I have just returned home from a routine operation in hospital. Having been blessed with good health throughout life, this was a completely new experience. Of course I had visited many people in hospital over the years, but this was different: I was now the patient. For a brief period this place was my home: I was an insider, not a visitor.
On reflection it occurred to me that I might use the short stay as a basis for entering into some of the experiences and feelings of a child or young person living away from home. It’s not that I haven’t tried to empathise with such children for most of my life: now I was united with them, in that power over my life had been temporarily handed over to others.
And that is the first reflection: I had a room in a private hospital paid for by the NHS as a way of guaranteeing an operation that had originally been scheduled for a year ago. In many ways it was not unlike a hotel room: bed, armchair, the dominating and inescapable television screen, and a bathroom en suite. And the room service was rather like that in a hotel: polite and tidy. So why, as I sat in this room and rested on the bed, was my experience so different,? Simply and solely, that I had handed over my well-being to others. My life was now in their hands.
Whatever choices I had, and there were several throughout my short stay, the one choice that was not open to me, was that of leaving. It was the powerlessness that struck me forcibly. Others would take decisions about me, monitor me, and talk about me as professionals. No amount of involvement in reviews or discussions with the professionals concerned could disguise the stark truth that I was the object of their treatment and care.
Next, I was surprised that although it hung prominently in the corridor en route for my room, I was not interested in the Mission Statement of the hospital. Up until my patient status I had always read such statements thoroughly, scrutinising each phrase and using them as a basis for evaluating what I saw going on.
You might therefore expect that now I was patient I was likely to be even more interested and eagle-eyed! So why not? I guess that now the boot was on the other foot policy statements did not count for much: the only thing that mattered was what happened in practice. And this helped me to see that Vision and Mission Statements are likely to mean a lot more to the professionals and providers than to those they are employed to help.
Carrying the Can
Third, I soon wished that there were such a thing as a matron whom I knew personally: someone who was ultimately responsible for everything that went on and with whom I could speak. It was not that anything exceptional occurred, or that I had issues of huge import to share. Rather that my room was invaded (after polite knocks, of course) by a sequence of professionals each with her or his own specific tasks, and that it would have been good once a day to speak with someone about how the whole package added up, and to ask questions that did not fall within the brief (or contracts) of any of the individual players.
The way life is, there is always custard that slips between the prongs of the fork. Let me give a small and intentionally simple and practical example. Due to regular trips to the bathroom after my operation the waste bin became filled with tissues and gauzes during the night. It needed emptying. The night nurse informed me that this would happen in the morning: so in the meantime I had to perch additional materials carefully on top of the lid. In the morning I mentioned this to the new team of nurses. They informed me that it was something that the cleaners would take care of. In the event it was not emptied during my stay by anyone.
It made me wonder how often children and young people who are looked after are told that someone else holds responsibility for a particular task, and that in time the child discovers that the status quo will have to be accepted. (For the record, my guess is that a matron would have taken a lively interest in this potential risk and health hazard, but for the purposes of this piece that is beside the point.)
Whatever their new nomenclature (Director of Nursing etc.) there was no one whose responsibilities were as comprehensive or corresponded with those of a traditional matron. And I wondered whether, with the demise of matrons in both residential care and hospitals, we had lost something much more important than we have realised. (I am aware that you may read this as a nostalgic longing for a bygone age.)
This brings me to the consultant who referred me to the hospital and performed my operation. I had known him for three or more years, unlike any of the other staff, and so most matters were shared with him. He came to see me on three occasions over the weekend, which indicated genuine commitment to my well-being. He was relaxed and informative and, as providence would have it, had trained at the same hospital as my wife. Not surprisingly we talked of the old days at the teaching hospital and the subject of matrons came up: the abiding myth that everyone was in fear of the matron, consultants included, was alive and kicking!
A final point: as one who uses the distinction between I-Thou and I-It relationships as foundational in my life and work (the terms were coined by Martin Buber), it was pretty obvious that those who looked after me related to me predominantly in one or other of these ways. There was a sister who came in, busy and unsmiling, to check that all regular monitoring had been done. She achieved her task, but made me feel like a cog in a machine, and perhaps she did too. At the other extreme was a night nurse who cared for me tenderly and with whom I the longest and deepest conversation about life, the universe and everything!
What is striking about relationships categorised in this way is that the quality of the relationship is not determined or prescribed by the nature of the role or task. And this reminded me that so often as I read the life stories of young people in the care system, it was someone like a cook or gardener, to whom they related most humanly, rather than the key worker, social worker, therapist or whoever.
I will leave it at that, because the effects of the anaesthetic haven’t fully worn off and I might already have left readers bemused with my ramblings. All the same, a brief, seemingly effective, and largely pleasant hospital experience has opened my eyes to aspects of the nature of residential care in a new way. Could I have acquired similar insights by reading or role-play, or is it necessary to sit where others sit, before we really begin to understand them? However good the literature or training, I suspect it is the latter.